Inspection on 30/07/09 for Greenacre

This is the latest available inspection report for this service, carried out on 30th July 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Greenacre Cleveland Gardens Trowbridge Wiltshire BA14 7LX Lead Inspector Alyson Fairweather Key Unannounced Inspection 30th July 2009 09:00 DS0000072687.V376469.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Greenacre DS0000072687.V376469.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Greenacre DS0000072687.V376469.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenacre Address Cleveland Gardens Trowbridge Wiltshire BA14 7LX Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01225 764935 01225 764935 ExcelCare Service Limited Mr Mahendranath Kawol Care Home 14 Category(ies) of Dementia - over 65 years of age (14), Old age, registration, with number not falling within any other category (14) of places Greenacre DS0000072687.V376469.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC. To service users of either gender whose primary needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia aged 65 years or over on admission (Code DE(E)) 2. The maximum number of service users who can be accommodated is 14. This is the first inspection. Date of last inspection Brief Description of the Service: Greenacre is a converted and extended house built in the 1960s. All of the residents accommodation is to the ground floor. There are three double bedrooms and eight single bedrooms. Two of the double bedrooms have ensuite toilet facilities and three of the single bedrooms have ensuite toilets. There are 2 bathrooms, a large sitting room and a separate dining room. There is a large paved area to the front of the building and a smaller paved area to the rear. There is a well-kept lawn outside and ample on-street parking. Greenacre is registered for a total of 14 places for either older people or older people with dementia. The staffing rota provided for 2 care staff from 8.00am until 8.00pm. At night there is one member of staff sleeping in and one waking night staff. The provider, Mr Kawol, bought the premises, and was registered as a new care home early in 2009. Most of the current residents were already living in the home. There is no intermediate or nursing care provided. Most residents are funded by the local authority, and the fees vary from £350 to £500 per week. Additional charges are made for hairdressing, and various other sundry goods. Greenacre DS0000072687.V376469.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes. This unannounced inspection took place over one full day. We reviewed the information that we had received about the home before we went, and we sent out surveys to the residents, to family members, to staff and to healthcare professionals, so that we could get their views about the home. Six residents replied, with help from their family, six family members wrote to us, as well as one member of staff and two healthcare professionals. We met some of the residents who have live in Greenacre, as well as some relatives and staff, the manager and the owner. We looked around the home and saw a number of records, including care plans, risk assessments, health and safety procedures, staff files and medication records. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visit. What the service does well: Residents said they enjoyed living in Bluebell Lodge, and their relatives spoke highly of the staff, saying they were very well looked after. Links between residents and their families, are supported and encouraged by staff, and they try to maintain people’s independence as much as possible. One person said: “It has a friendly and family feel. Another reported, I find it a happy place to spend my time, and another: Im well looked after and comfortable. Care plans showed appreciation of peoples needs. As well as care plans for personal and physical care such as pressure area care and mobility, there was also consideration of peoples preferences in respect of recreational and spiritual needs. Where people had specific medical conditions, these were reflected in their care plans. This meant staff had guidance on what it meant to have a particular condition, and what signs might indicate discomfort or deterioration. Areas of risk are highlighted in the care plans, and assessments are undertaken, which helps to ensure that people are safe in the things that they do. Records showed a high level of liaison with GP practices, and support to people to maintain appointments with consultants, opticians and clinics. Staff were Greenacre DS0000072687.V376469.R01.S.doc Version 5.2 Page 6 supported by the Community Mental health Team (CMHT) and asked for advice when it was needed. One community nurse who visits the home said that if she gave any specialist advice, it was incorporated in the care plan, and that she was satisfied with the overall care provided to residents in the home. There is a good complaints procedure in the home, which is kept in the hall and is easily accessible. One family member told us: All problems are seen to as soon as they are reported to staff. Residents can entertain family or friends either in the privacy of their own bedrooms or in the communal areas available. Staff encourage and support links between residents and their families, although the frequency of contact varies depending on individual circumstances. Some family members keep in touch with regular phone calls. All the relatives we spoke to said that they were consulted about their relative’s care if the individual concerned was not able to make decisions. One person who wrote to us said: In my opinion Greenacre provide my wife with everything she requires. Another wrote: The service and attention provided are first rate. The staff are attentive and the residents appear to be contented. Other comments included: I am, generally, very pleased with the care afforded to my relative. The home is clean, warm and friendly; We are very happy with the care provided by Greenacre and our relative has settled in well. Its a very well run home; Greenacre welcomes carers and families and makes them feel valued and involved in their relatives care. What has improved since the last inspection? What they could do better: The home seeks to identify and meet peoples social, religious and recreational needs, although comments received from others seem to indicate some unhappiness with the level of activities available. One relatives commented: Maybe they could have a day sometimes, and another, More one-to-one contact, more socialising with staff outside. People are left for long periods with, apart from TV, nothing to interest them. Another said they would like “Some picnic teas outside on sunny days. The medication procedures in place were good, but there had been a couple of errors made. The manager is aware of these and has put in extra safeguards. Greenacre DS0000072687.V376469.R01.S.doc Version 5.2 Page 7 The premises were in good order, although the building itself was built in the 1960s. There were a couple of areas which needed improvement, and these included the flooring in the kitchen and laundry, and the fitting of thermostatic controls. The provider has been asked to put new, non slip flooring in the two named areas, and to give us an action plan on when the thermostatic controls will be introduced. The laundry room also doubles as a staff room, and the provider has been asked to consider making a fully self contained laundry, so as to limit any risk of cross-infection. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Greenacre DS0000072687.V376469.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greenacre DS0000072687.V376469.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Prospective residents are informed about the services offered by the home, in order to help them decide if they want to move there. Everyone had an assessment of their needs, and the home was able to demonstrate that it could meet the needs of its residents. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Greenacre has a statement of purpose and service users guide, which describe the services offered. This is given to either the resident or their family member when a referral is made to the home. There are also copies in the hallway of the home so that people can see them. Greenacre DS0000072687.V376469.R01.S.doc Version 5.2 Page 10 Five of the six residents who wrote to us said that they felt they had enough information to help you decide if Greenacre was the right place for them. When we asked family members, people said that the home meets the needs of their relatives. As the new owner, Mr Kawol, took over the home with the residents in situ, all the previous assessment information was in place. However, in order that he and his staff could establish the level of need of their residents, a new assessment was conducted. A detailed range of information was obtained, including information on mobility, communication, specific health needs, medication, dietary preferences, social interests and family circumstances. We spoke to several relatives during our visit, and all of them said they were happy with the service offered to them and their family members. The health professional who wrote to us said that the service’s assessment arrangements ensure that accurate information is gathered and that the right service is planned for people. There were no intermediate care beds in Greenacre. Greenacre DS0000072687.V376469.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Residents have all their health, personal and social care needs set out in care plans. Their health needs are fully met. Residents are protected by the homes medication procedures, although there are some areas which need improved. People feel they are treated with dignity and respect. People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Care plans were in place for all residents and showed evidence of regular review. Care staff were seen to use the care plans as working documents, seeking information from them and adding entries as necessary. Whilst talking to staff, it was clear that they were aware of individuals needs, and daily records reflected this. Information on care plans related to sleep routines, eating, communication, mobility, personal care, emotional well being, a Greenacre DS0000072687.V376469.R01.S.doc Version 5.2 Page 12 medical report, and socialisation likes and dislikes. There was evidence that pressure care was monitored and hydration charts and movement charts were kept. There were monitoring charts in place for people who had to be weighed on a regular basis, and care plans were in place in regard to diet, with input from the dietician. The staff member who wrote to us said they were given up-to-date information about the needs of the people they support in the care plan. All residents are registered with a General Practitioner (GP) and there is input from other health professionals, such as dentists and opticians as required, with appointments being recorded in the care plan. There was evidence of links with the local mental health team for some residents, with Care Programme Approach (CPA) notes on file. Weight checks are done for residents on a regular basis, and when we looked at fluid charts, they had been filled in correctly, noting the full amount of fluid taken by residents in a day. We saw that one chart was showing a very poor fluid intake, and there were no instructions on the chart for care staff about what to do if the total is under a certain amount. We have asked the manager to make sure that these instructions are recorded on the chart. Records showed that emergency services are sent for quickly if needed. One community nurse who visits the home said that if she gave any specialist advice, it was incorporated in the care plan, and that she was satisfied with the overall care provided to residents in the home. There were various risk assessments in place, for example when using a hoist, or for when people lose weight. When we asked if the home makes sure that they get the medical care they need, all six residents who wrote to us said: “Always”. Medication is stored securely in the home, and staff do not administer medicines until they have received appropriate training. Information about various medicines is available in the home and we saw staff manage a medication round well. We noted that a fortified nutrient which was prescribed for one resident had not been delivered, and the manager and staff were busy contacting the chemist to make sure it was sent. All the medication administration records checked were clear, although one had not been signed by staff when medication had been given. The manager has been asked to make sure that all medications are signed for when administered, so that it is obvious that people have had their medication as prescribed, and makes it easier to check stock left in the medication cupboard. When we did a stock check on some of the medication, most of it was correct. However, there were two occasions where the number of tablets in the box did not tally with the number which should have been there. The manager has Greenacre DS0000072687.V376469.R01.S.doc Version 5.2 Page 13 been asked to make sure that a stock check is conducted regularly in order to spot any mistakes. Since the inspection, the manager has told us of several changes which have been made to tighten up the medication procedures. All residents and relatives we spoke to confirmed satisfaction with staff members and expressed that his or her privacy and dignity were respected at all times. Staff were observed knocking on doors and residents were spoken to with their preferred form of address. All personal care was given appropriately and staff respected people’s wishes when they wanted to spend time in their room with their family members. Staff induction training makes it clear that the homes expectation is that residents will be treated with dignity, and that their independence and self esteem must be encouraged. All relatives we spoke to said that they could visit their relative in private. The community nurse who wrote to us said: Staff will always ask for support/intervention when concerned about a resident. Greenacre DS0000072687.V376469.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 The home seeks to identify and meet peoples social, religious and recreational needs, although comments received from others seem to indicate some unhappiness with the level of activities available. There are no barriers to contact with family and friends, and people are able to make some decisions about every day life wherever possible. People are offered a choice of good quality meals, which take account of dietary needs. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The families we spoke to reported that residents follow a routine and that many choose to stay in the sitting room with the others. Many of the residents have dementia, and the activities which are on offer to date have been somewhat limited. A care assistant has been designated the task of providing activities, and these have included playing skittles, films, and a sing-a-long. There is a regular church service held. There are written instructions for the carers about the purpose of activities, eg to reinforce social, cognitive and Greenacre DS0000072687.V376469.R01.S.doc Version 5.2 Page 15 sensory skills. When we asked residents’ families about what activities were provided, they said: Not much. Relatives who wrote to us also said that they would be happier if there were more structured activities for their family member. One said that “They could do better. Maybe a day out would be good” Another relative said that they would like “More one-to-one contact, with more socialising with staff outside the home. People are left for long periods with, apart from TV, nothing to interest them. Another person, however, reported: My relative gets taken for walks and helps to plant bulbs in the garden”. We have asked the manager to make sure that residents are given more formal opportunities to take part in activities. We have recommended that the provider should consider appointing a specific activities co-ordinator, and should seek advice from an outside agency about appropriate activities for older people with dementia, eg the National Association for Providers of Activities for Older People, or the Alzheimer’s Society. Residents can entertain family or friends either in the privacy of their own bedrooms or in the communal areas available. Staff encourage and support links between residents and their families, although the frequency of contact varies depending on individual circumstances. Some family members keep in touch with regular phone calls. All the relatives we spoke to said that they were consulted about their relative’s care if the individual concerned was not able to make decisions. One relative who was visiting the home said: “Mum’s very happy here, so if she’s happy, we’re happy”. Care plans showed that peoples preferences about food were gathered by care staff and the manager, and passed to the cook, who has been employed at the home for a number of years. The person who was doing the cooking has also been employed as a carer, and therefore cannot devote her time to simply catering for the residents. When we spoke to her, she had just completed a course on Diabetes, and was aware of how diet could impact on this condition. She told us that some residents needed food supplements, and was aware of how to use full cream milk etc when people were undernourished. There was a good supply of fruit and vegetables in stock. The dishwasher was broken when we visited, but the manager was in the process of having it repaired. The cook said that it broke frequently. Given that the cook works alone, and that she is also used as a carer, the provider should consider investing in a new dishwasher. At one point during the day, we saw the cook leaving the kitchen to spend time with the residents in the lounge. She was still wearing the apron which had been used in the kitchen, and we advised the manager that this should be removed in the interests of infection control. Where a person needed assistance to eat, this was provided with a sensitive approach. Meals were portioned to match peoples appetites and tastes. During Greenacre DS0000072687.V376469.R01.S.doc Version 5.2 Page 16 the afternoon there was a hot drinks round, and this included the offer of biscuits. Of the six people who wrote to us, two said they “Always” liked the food, three said: “Usually” and one person said: “Sometimes”. We have recommended to the manager that when the staffing levels increase, it would be good practice for the home to employ a full time cook. Greenacre DS0000072687.V376469.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Residents and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. The policies and procedures which the home has in place ensure that residents are protected from abuse, although all staff must have training in safeguarding adults. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has a complaints procedure in place, and this is given to service users and their families. There is a complaints log in place, and complaints were seen to be dealt with promptly by the manager. The procedure is kept in the hallway so that all relatives can see it. There have been no complaints received by the Care Quality Commission (CQC). Staff spoken to interests of the they knew who complaint. One were clear that they wished the service to be run in the service users. All the residents and relatives we spoke to said to speak to if they were not happy and knew how to make a said: “We have not had cause to complain”. The home has copies of the “No Secrets” document, as well as the organisational policy and procedure on responding to allegations of abuse. Greenacre DS0000072687.V376469.R01.S.doc Version 5.2 Page 18 They also have a copy of “Keeping People Safe in Wiltshire”. All staff members are encouraged to report any incidences of poor practice, and a “Whistle Blowing” procedure is available. Only two staff were seen to have had training in the Safeguarding Adults, and we have told the manager that all staff must have this training. There have been no referrals made to the vulnerable adults unit. The healthcare professional who wrote to us said that the care service “always” responded appropriately if they raised any concerns. Greenacre DS0000072687.V376469.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Service users live in a clean, homely and comfortable environment which has been adapted to meet their needs. The home is clean and hygienic. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Greenacre is a converted and extended house built in the 1960s. All of the residents accommodation is to the ground floor. There are three double bedrooms and eight single bedrooms. Two of the double bedrooms have ensuite toilet facilities and three of the single bedrooms have ensuite toilets. There are 2 bathrooms, a large sitting room and a separate dining room. Each room is fitted with a central nurse call system as well as in the communal Greenacre DS0000072687.V376469.R01.S.doc Version 5.2 Page 20 areas. It was registered under the new owner, Mr Kawol, early in 2009. Information about the premises is provided in the Statement of Purpose There is a large paved area to the front of the building and a smaller paved area to the rear. Residents were said to enjoy sitting out there in the summer. There is a well-kept lawn outside and ample on-street parking. Greenacre has a laundry room with domestic style machines. Unfortunately, these are placed in the staff room, and has been laid with lino. The kitchen has recently been fitted with new cupboards, but also has been laid with lino. As such, these floors could be dangerous in the event of spills. The manager has been asked to make sure that the floors in the kitchen and the laundry are laid with purpose made, non-slip material. He has also been asked to consider making a fully self contained laundry, so as to limit any risk of cross-infection. There were no unpleasant odours present when we visited the home, and there is a daily cleaning schedule. All staff have had infection control training. Some people told us that the home was “always” clean and tidy, and some said “mostly”. Greenacre DS0000072687.V376469.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The home has the number and skill mix of staff to meet residents’ care needs. They are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their job, which means that residents are in good hands. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Greenacre is registered for a total of 14 places for either older people or older people with dementia. The staffing rota provided for 2 care staff from 8.00am until 8.00pm. At night there is one member of staff sleeping in and one waking night staff. The home has a cleaner and a cook/carer. There are senior carers who take responsibility for more junior staff. Some people have completed an NVQ Level 3 and two carers have started it. Residents and their relatives told us that staff were “usually” available when they needed them, although two people said “always”. One staff member told us that there were “always” enough staff to meet the individual needs of all the people who use the service. The manager reported that they are currently recruiting new staff. Greenacre DS0000072687.V376469.R01.S.doc Version 5.2 Page 22 One relative told us: In my opinion Greenacre provide my wife with everything she requires. Another said: The service and attention provided are first rate. The staff are attentive and the residents appear to be contented. The healthcare professional who wrote to us said: “The services managers and staff have the right skills and experience to support peoples social and health care needs. The staff member who wrote to us said that they “always” felt they have enough support, experience and knowledge to meet the different needs of people who use services. This included needs relating to disability, age, gender, race and ethnicity, sexual orientation and faith. Greenacre’s recruitment procedures should include Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks, two written references and a medical declaration. Photographic ID should also be on file. All potential staff complete an application form, and this is kept by the home. Most of the staff files we looked at contained all the appropriate information. There was one file where the application form was not fully completed, with some dates of previous employment being omitted. There was no record of the person being questioned about this at interview. There was no medical declaration on file either. The providers have been reminded that all potential staff must be questioned about gaps in their employment record and provide information about their physical and mental health. This is so that they can be sure that residents are supported by people who are fit to do so. The staff member who wrote to us confirmed that their employer had carried out checks, such as CRB and references before they started work. Greenacre has a good training plan in place. We saw that new care staff had induction training, and one staff member confirmed that the induction covered everything they needed to know to do the job when they started. They have recently provided training courses for staff in several areas. This includes infection control, fire awareness, manual handling, medication administration, and diabetes training. One person held a certificate in caring for People with Dementia, but it is recommended that more staff have this training, as many of the residents in the home have Dementia. Most people have current Food Hygiene certificates. It is planned to offer staff training on the Mental Capacity Act in the future. The staff member who wrote to us said that they were being given training which was relevant to their role, helps them understand and meet the needs of service users, keeps them up to date with new ways of working and gives them enough knowledge about healthcare and medication. Greenacre DS0000072687.V376469.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Residents live in a home which has good management systems in place. Their opinions are being sought as to how the home should best be run, although the introduction of a formal quality assurance system would support this. Residents’ financial interests are safeguarded, and their health, safety and welfare are promoted and protected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The owner of the home, Mr Kawol, is currently the registered manager as well. He has appointed a day to day manager, Mr Mohun, who will shortly be making an application to CQC to become the registered manager. Both Mr Kawol and Greenacre DS0000072687.V376469.R01.S.doc Version 5.2 Page 24 Mr Mohun have achieved their Registered Manager’s Award, and Mr Kawol has an RMN, and BSc qualification. Mr Mohun has the advantage of living upstairs from the home, so can be reached quickly if there was ever an emergency. When we asked relatives what the home does well, one person said: “Well, we’re doing well with the new management. They’re very good. The providers have completed an Annual Quality Assurance questionnaire for Residents, relatives, staff and viasiting professionals. This gives people a chance to say what they think of various aspects of the home. The results of these surveys are collated, and an action plan drawn up of how what needs to be done and when it will be done by. This is then signed for by the manager when completed. Consideration should be given to using an independent advocacy service for people with dementia to help with this. The owner has achieved the Investors in People Award in another home, so consideration will be given to applying for that in due course. There is no structured quality assurance system used by the owners. In discussion, they said that they were still investigating different systems, and that they would introduce one imminently When the owner is no longer in day to day charge of the home, they must visit the home and produce a report of his visit at least once a month. Mr Kawol explained that he visits much more frequently than that, but has agreed that he will undertake this monthly report once Mr Mohun is registered as manager. Of the six residents who wrote to us, three people said that staff “Always” listen to them and act on what they say, and three people said: “usually”. Few residents manage their own financial affairs. Many are subject to a Power of Attorney, and either family members or legal advocates support their finances. Full records are kept of residents’ expenses, and receipts are tallied alongside expenditure. Fees can be paid directly, by cheque or by standing order. Residents are responsible for minor expenditure such as hairdressing, chiropody, toiletries and newspapers. The home has detailed health and safety policies and procedures in place. One staff member takes responsibility for fire safety procedures, and a new fire risk assessment was conducted in April 2009. A series of daily, weekly and monthly checks are done, including fire detection, call equipment, electrical testing and water temperature testing. Fire extinguishers had been checked in June 2009. The fire risk assessment showed that not all water outlets were thermostatically controlled, and the provider has been told that he must have a plan of action in place for when this will be done. Greenacre DS0000072687.V376469.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Greenacre DS0000072687.V376469.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP8 Regulation 13 Requirement Where fluid charts are used for residents, there must be instructions for care staff about what to do if the total is under a certain amount. All staff must sign the Medication Administration Record whenever they administer medication to a resident. There must be a regular audit of medications stored in the home. Residents must be given more formal opportunities for activities. The floors in the kitchen and the laundry must be laid with purpose made, non-slip material. All staff files must contain information as to the physical and mental health of a potential staff member, as well as a satisfactory explanation about any gaps in their employment record. A system must be established which evaluates the quality of the services provided at the care home. Timescale for action 30/09/09 2 OP9 13 30/09/09 3 4 5 6 OP9 OP12 13 16 13 19 30/09/09 30/10/09 30/11/09 30/10/09 OP19 OP29 7 OP33 24 30/11/09 Greenacre DS0000072687.V376469.R01.S.doc Version 5.2 Page 27 8 OP38 13 The provider must have an action plan in place which shows how he will complete the water thermostatic controls. 30/11/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP1 OP12 Good Practice Recommendations The home’s Statement of Purpose should be amended to mention the Care Quality Commission (CQC) instead of the previous body. It should also give the new address. The provider should consider appointing a specific activities co-ordinator, and should seek advice from an outside agency about appropriate activities for older people with dementia, eg the National Association for Providers of Activities for Older People, or the Alzheimer’s Society. As the cook is also a carer, and we advised the manager that the kitchen apron should always be removed in the interests of infection control. The provider should consider employing a full time cook to cater for residents. The provider should consider investing in a new dishwasher in the kitchen in order to help the cook with her tasks. The provider should consider making a fully self contained laundry, so as to limit any risk of cross-infection. It is recommended that all staff receive training specific to caring for people with Dementia. Consideration should be given to the use of an independent advocacy service to help get feedback from residents with dementia about the quality of the service provided. 3 OP15 4 5 6 7 OP15 OP19 OP30 OP33 Greenacre DS0000072687.V376469.R01.S.doc Version 5.2 Page 28 Care Quality Commission South West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.southwest@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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